Increased Risk for Vitamin D Deficiency in Obese Children with Both Celiac Disease and Type 1 Diabetes

Abstract

Background. It is unknown whether the coexistence of type 1 diabetes (T1D) and celiac disease (CD) increases the risk for vitamin D deficiency. Aims. To determine the vitamin D status and the risk for vitamin D deficiency in prepubertal children with both T1D and CD compared to controls, TID, and CD. Subjects and Methods. Characteristics of 62 prepubertal children of age 2–13 y with either CD + T1D (n = 22, 9.9 ± 3.1 y), CD only (n = 18, 8.9 ± 3.3 y), or T1D only (n = 22, 10.1 ± 2.8 y) were compared to 49 controls of the age of 8.0 ± 2.6 years. Vitamin D deficiency was defined as 25(OH)D < 50 nmol/L, overweight as BMI of >85th but <95th percentile, and obesity as BMI > 95th percentile. Results. The 4 groups had no difference in 25(OH)D (ANOVA P = 0.123) before stratification into normal-weight versus overweight/obese subtypes. Following stratification, 25(OH)D differed significantly between the subgroups (F (3,98) = 10.109, ANOVA P < 0.001). Post-hoc analysis showed a significantly lower 25(OH)D in the overweight/obese CD + T1D compared to the overweight/obese controls (P = 0.039) and the overweight/obese CD (P = 0.003). Subjects with CD + T1D were 3 times more likely to be vitamin D deficient (OR = 3.1 [0.8–11.9], P = 0.098), compared to controls. Conclusions. The coexistence of T1D and CD in overweight/obese prepubertal children may be associated with lower vitamin D concentration.

Endocrine manifestations in celiac disease

“…Time course studies of diagnosis of type 1 diabetes and CD suggests that diagnosis of type 1 diabetes usually occurs first, followed by CD[ 63 - 66 ]. In patients with type 1 diabetes and celiac disease, additional autoimmune diseases may later develop, particularly autoimmune thyroid disease[ 67 - 69 ]. Moreover, risk of disease complications, including bone disease, retinopathy or nephropathy may occur, particularly if concomitant CD is present[ 67 - 71 ], and symptoms associated with CD may be more difficult to resolve if type 1 diabetes is also present[ 69 ].…”

“…In patients with type 1 diabetes and celiac disease, additional autoimmune diseases may later develop, particularly autoimmune thyroid disease[ 67 - 69 ]. Moreover, risk of disease complications, including bone disease, retinopathy or nephropathy may occur, particularly if concomitant CD is present[ 67 - 71 ], and symptoms associated with CD may be more difficult to resolve if type 1 diabetes is also present[ 69 ]. Finally, a gluten-free diet (if CD is present) may lead to better glycemic control and protect patients against development of diabetes-related vascular complications[ 70 ].…”

Vitamin D induces autophagy of pancreatic β-cells and enhances insulin secretion

“…Numerous epidemiological studies have suggested that vitamin D may have a role in defense against diabetes (5,6). Vitamin D deficiency is prevalent among the diabetic population; early and long-term vitamin D supplementation is associated with a decrease in the risk of developing diabetes, and the incidence of T1DM is greater in areas with fewer days of sunlight per year (7,8). However, the underlying mechanisms of the involvement of vitamin D in T1DM remain to be elucidated.…”

The Relationship between Selected Inflammation and Oxidative Stress Biomarkers and Carotid Intima-Media Thickness (IMT) Value in Youth with Type 1 Diabetes Co-Existing with Early Microvascular Complications

“…Other studies showed lower vitamin D levels in overweight patients and ones with T1D [ 69 , 70 ]. Vitamin D supplementation was associated with improved blood vessel function in children with diabetes [ 70 , 71 ]. Whether vitamin D supplementation can be preventive in the general population or those likely to develop CVD is still open to debate [ 72 , 73 ].…”